I’ve been tired all day, which is nothing new, as fatigue and multiple sclerosis go hand in hand. It’s been one of my primary symptoms since I was diagnosed in 1980.
The year before I retired eight years ago, I’d occasionally start to doze off in my office, or worse, while driving home from work. Recently, I began to wonder if Provigil was working for me at all. Today, while visiting our young grandkids, I was dragging; my eyes were open, but I had no energy, even though I’d taken my medication less than two hours earlier.
Could the benefits be in my head?
Interestingly, a day earlier, I read a study in The Lancet Neurology that looked at three medications commonly prescribed for MS fatigue: modafinil, methylphenidate, and amantadine. (In the U.S., methylphenidate is marketed as Ritalin, among others.) The results surprised me.
In the study, 136 MS patients who had their fatigue measured by the Modified Fatigue Impact Scale (MFIS) were rotated through the trio of fatigue medications plus a placebo, spending six weeks on each. Their fatigue levels were measured based on the MFIS after each medication.
Guess what? The medications appear to have done no better than the placebo. Take a look at the estimated mean values of MFIS total scores at baseline and the maximal tolerated dose for each:
- Score at baseline: 51.3
- Score after placebo: 40.6
- Score after amantadine: 41.3
- Score after modafinil: 39.0
- Score after methylphenidate: 38.6
Also, while the medications didn’t prove to be better than the placebo in improving MS fatigue, they did result in more frequent adverse events. So, considering the risks and the benefits, the researchers concluded that “the results of this study do not support an indiscriminate use of amantadine, modafinil, or methylphenidate for the treatment of fatigue in multiple sclerosis.”
Does this surprise you?
People with MS have been using these medications for years in an effort to tame the fatigue monster, so it’s no wonder I was surprised by these results. Maybe I shouldn’t have been. The folks at the National MS Society (NMSS) remind us that no medications are approved specifically to treat MS fatigue. Everything that people with MS use is prescribed off-label.
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